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Bee and wasp stings, from local swelling to anaphylaxis, and venom immunotherapy.

Most stings settle in a day. A few become dangerous. This guide covers what to do at the roadside, in A and E, and in the allergy clinic.

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Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against BSACI, Resuscitation Council UK and NICE guidance you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including venom immunotherapy, two adrenaline autoinjectors and mastocytosis screening.

Key facts

Bee and wasp stings at a glance.

The essentials in plain English: the insects, the reaction types, and what UK allergy specialists can offer.

  • What it is

    A reaction to Hymenoptera venom from honey bees (Apis), bumblebees (Bombus), wasps (Vespula, Vespa) and hornets. Ranges from a local sting to anaphylaxis.

  • Local reaction

    Immediate pain, redness, swelling and itching at the sting site. Settles within 24 to 48 hours with simple measures.

  • Large local

    Swelling greater than 10 cm lasting more than 24 hours. Mimics cellulitis but is IgE mediated, not infective.

  • Systemic allergic

    Urticaria, angioedema, bronchospasm and anaphylaxis, driven by venom-specific IgE. Needs immediate treatment.

  • Toxic reaction

    Multiple stings can cause rhabdomyolysis, acute kidney injury and haemolysis. Around 100 stings can be fatal in an adult, 20 in a child.

  • Venom immunotherapy

    A three to five year course of subcutaneous injections at BSACI-accredited centres. Around 95 per cent protection for wasp and bee venom.

Why this guide matters

Prepare once, respond quickly.

Anaphylaxis is rare but time critical. Preparation and a specialist plan turn a life-threatening reaction into a manageable one.

  • Adrenaline first, everything else after

    In anaphylaxis, intramuscular adrenaline is the only treatment that saves life. Antihistamines and steroids come later.

  • Reaction type dictates follow-up

    A single local reaction usually needs nothing more. A systemic reaction always needs allergy referral.

  • Immunotherapy is worth asking about

    Venom immunotherapy is under-used in the UK. It offers around 95 per cent protection over three to five years.

How the diagnosis is made

From the moment of the sting to a long-term plan.

The steps a UK GP, A and E team or allergist will normally follow, in order, so you know what to expect and why.

  1. 01

    Assessing

    Identify the insect

    Bee, wasp or hornet? Honey bees usually leave a barbed stinger in the skin. Wasps and hornets do not and can sting repeatedly.

  2. 02

    Assessing

    Classify the reaction

    Local, large local, systemic allergic or toxic. This decides both immediate treatment and follow-up.

  3. 03

    Assessing

    Assess for anaphylaxis

    Airway compromise, breathing difficulty or circulatory collapse means immediate intramuscular adrenaline and 999.

  4. 04

    Confirming

    Venom-specific IgE testing

    Serum-specific IgE for honey bee, wasp and hornet venom, taken at least four weeks after the reaction to avoid a false negative.

  5. 05

    Confirming

    Skin prick and intradermal

    Performed in a specialist allergy clinic to confirm the culprit venom and its threshold, using both skin prick and intradermal testing.

  6. 06

    Preparing

    Baseline serum tryptase

    Every adult with a severe systemic reaction should have a baseline tryptase to screen for underlying mastocytosis.

  7. 07

    Preparing

    Allergy clinic referral

    Anyone with a systemic reaction is referred to a BSACI-accredited centre to consider venom immunotherapy and prescribe two adrenaline autoinjectors.

Typical timeline: clinic assessment within weeks; venom immunotherapy over three to five years.

Symptoms

What a sting actually feels like.

The typical local picture, the large local pattern that mimics cellulitis, and the systemic features that mean you need adrenaline now.

  • Immediate sharp pain

    A hot, stinging pain at the site within seconds of the sting. Usually the loudest symptom in the first minute.

  • Local redness and swelling

    A red weal a few centimetres across, warm to touch, itchy and tender. Settles inside 24 to 48 hours.

  • Large local swelling

    Swelling greater than 10 cm that peaks at 48 to 72 hours. Not infection, though it looks like cellulitis.

  • Urticaria and angioedema

    Widespread hives, lip and eyelid swelling within minutes. A signal that the reaction has become systemic.

  • Bronchospasm and wheeze

    Chest tightness, wheeze or shortness of breath. Treat as anaphylaxis until proven otherwise.

  • Cardiovascular collapse

    Dizziness, pallor, tachycardia, hypotension or collapse. Immediate intramuscular adrenaline and 999.

  • Retained stinger (bees)

    A tiny black barb in the skin, sometimes with a pale venom sac attached. Scrape it out sideways, never squeeze.

  • Red flag: multiple stings

    More than 20 stings in a child or 100 in an adult risks rhabdomyolysis, haemolysis and acute kidney injury. Attend hospital.

Treatment

How stings are treated in the UK.

Simple measures for a local sting, oral steroid for a large local, intramuscular adrenaline for anaphylaxis, and venom immunotherapy for lasting protection.

  • Scrape the stinger out

    Only bees leave a barbed sting. Scrape it out sideways with a fingernail or card. Squeezing or using tweezers pumps in more venom.

  • Ice, analgesia and antihistamine

    Cold pack for ten minutes, paracetamol or ibuprofen, and a non-sedating oral antihistamine such as cetirizine or loratadine.

  • Topical steroid for itch

    A short course of a mid-potency topical steroid, such as hydrocortisone one per cent, calms the local inflammatory response.

  • Oral steroid for large local

    A short course of prednisolone, typically three to five days, for swelling greater than 10 cm or reactions near the face or airway.

  • IM adrenaline for anaphylaxis

    Intramuscular adrenaline 1:1000, 500 micrograms in an adult, into the anterolateral thigh. Repeat every five minutes if needed and call 999.

  • Oxygen and IV fluids

    High-flow oxygen, supine position with legs raised and rapid IV crystalloid for hypotension follow the Resuscitation Council UK algorithm.

  • Two adrenaline autoinjectors

    Anyone with a systemic reaction should carry two autoinjectors (EpiPen, Jext or Emerade) at all times, with a written action plan.

  • Venom immunotherapy (VIT)

    A three to five year course of subcutaneous venom injections at a BSACI-accredited centre. Around 95 per cent protection for wasp and bee venom.

UK allergy centres offering venom immunotherapy

BSACI-accredited allergy services include Royal Brompton, Royal London, Guy's and St Thomas', Manchester, Cambridge Addenbrooke's, Southampton, Birmingham and Sheffield. Ask your GP for a referral if you have had a systemic reaction.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or allergist knows your history and can tell you which parts apply to you. In anaphylaxis, use adrenaline first and call 999.

  • BSACI. Guideline for the management of Hymenoptera venom allergy.

  • Resuscitation Council UK. Emergency treatment of anaphylactic reactions.

  • NICE CKS. Insect bites and stings.

  • MHRA. Adrenaline auto-injectors: updated advice.

Red flags

When a sting needs urgent attention.

Most stings need nothing more than ice and an antihistamine. These are the situations where you call 999 or attend the emergency department.

  • Airway or breathing compromise

    Stridor, hoarse voice, tongue swelling, wheeze or breathlessness. Immediate intramuscular adrenaline and 999.

  • Circulatory collapse

    Pallor, tachycardia, dizziness, hypotension or loss of consciousness. Lay flat, raise legs, adrenaline, 999.

  • Sting inside the mouth or throat

    Rapid oropharyngeal swelling can obstruct the airway even without allergy. Attend the emergency department.

  • Multiple stings

    More than 20 in a child or 100 in an adult can cause rhabdomyolysis, haemolysis and acute kidney injury. Hospital assessment.

  • Delayed serum-sickness reaction

    Fever, joint pain, rash and lymphadenopathy 7 to 14 days after a sting. Rare but needs review.

  • Vasculitis or nephritis

    Purpuric rash, blood in the urine or new kidney impairment days to weeks after a sting warrants urgent bloods and urinalysis.

  • Baseline tryptase elevated

    A raised baseline tryptase suggests mastocytosis and a lifelong risk of severe reactions. Refer to specialist haematology and allergy.

  • Beekeeper or occupational risk

    Frequent exposure raises the risk of sensitisation. Occupational assessment, action plan and often venom immunotherapy.

  • Pregnancy after a systemic reaction

    Anaphylaxis during pregnancy is treated identically. Ongoing VIT is usually continued but not initiated in pregnancy.

Living with it

A treatable allergy, with a clear plan.

Four things make the biggest difference: two autoinjectors, a written action plan, venom immunotherapy where indicated, and MedicAlert identification.

A quiet reminder

Beekeepers should have occupational advice.

Frequent stings raise the risk of sensitisation. Occupational health input, a written action plan and often venom immunotherapy are part of safe practice.

  1. 01 Carry

    Two adrenaline autoinjectors, always

    EpiPen, Jext or Emerade, kept together, in date and within reach. Practise with a trainer pen every few months.

  2. 02 Plan

    A written action plan

    A BSACI-style plan spells out when to use adrenaline, when to call 999, and what to say. Share it with family, work and school.

  3. 03 Consider

    Venom immunotherapy

    For anyone with a systemic reaction, VIT gives lasting protection and a return to normal outdoor life. Ask for allergy referral.

  4. 04 Identify

    MedicAlert and awareness

    A MedicAlert bracelet or pendant tells first responders about your venom allergy and any autoinjector prescription.

Frequently asked

Everything we get asked about bee and wasp stings.

Quick answers on stingers, hospital thresholds, autoinjectors and immunotherapy.

  • What is the difference between a bee, wasp and hornet sting?

    Honey bees usually leave a barbed sting in the skin and die after stinging. Wasps and hornets have smooth stings, can sting repeatedly and inject a different venom mixture. Allergy to one does not always mean allergy to another, which is why venom-specific IgE testing matters.

  • Should I pull the stinger out with tweezers?

    No. Scrape it out sideways with a fingernail, credit card or blunt edge. Squeezing the venom sac with tweezers pumps more venom into the skin and makes the reaction worse.

  • When should I go to hospital after a sting?

    Any breathing difficulty, throat tightness, dizziness, widespread rash or collapse means anaphylaxis until proven otherwise. Use your adrenaline autoinjector if you have one and call 999. Multiple stings, stings inside the mouth or a large local reaction near the airway also need urgent review.

  • What is venom immunotherapy?

    A three to five year course of small, gradually increasing venom injections given under the skin at a BSACI-accredited allergy centre. It retrains the immune system and gives around 95 per cent protection against future systemic reactions to wasp and bee venom.

  • Why do I need two adrenaline autoinjectors?

    Around one in five people with anaphylaxis need a second dose before help arrives, particularly if the reaction is severe or if paramedic response is delayed. UK and MHRA guidance recommends carrying two autoinjectors at all times.

  • What is mastocytosis and why does it matter?

    Mastocytosis is a condition where the body has too many mast cells, the cells that release histamine. It raises the risk of severe venom reactions and is screened for with a baseline serum tryptase. A raised result means specialist haematology and allergy referral, and a lower threshold for VIT.

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